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SECOND EDITION

Paula J. Woodward, MD

Professor

of Radiology

David G. Bragg, MD and Marcia R. Bragg Presidential Endowed Chair in Oncologic Imaging

Adjunct Professor of Obstetrics and Gynecology

University of Utah School of Medicine

Salt Lake City, Utah

James F. Griffith, MD, MRCP, FRCR

Professor

Department of Imaging and Interventional Radiology

The Chinese University of Hong Kong

Hong Kong (SAR), China

Gregory E. Antonio, MD, DRANZCR, FHKCR

Honorary Professor

Department of Imaging and Interventional Radiology

The Chinese University of Hong Kong

Consultant Radiologist

Scanning Department

St. Teresa’s Hospital

Hong Kong (SAR), China

Anil T. Ahuja, MBBS (Bom), MD (Bom), FRCR, FHKCR, FHKAM (Radiology)

Professor of Diagnostic Radiology & Organ Imaging

Faculty of Medicine

The Chinese University of Hong Kong

Prince of Wales Hospital

Hong Kong (SAR), China

K. T. Wong, MBChB, FRCR, FHKCR, FHKAM (Radiology)

Consultant & Clinical Associate Professor (Honorary) Department of Imaging and Interventional Radiology

Prince of Wales Hospital

Faculty of Medicine

The Chinese University of Hong Kong

Hong Kong (SAR), China

Aya Kamaya, MD, FSRU, FSAR

Associate Professor of Radiology

Director, Stanford Body Imaging Fellowship

Stanford University School of Medicine

Stanford, California

Jade Wong-You-Cheong, MBChB, MRCP, FRCR

Professor

Department of Diagnostic Radiology and Nuclear Medicine

University of Maryland School of Medicine

Director of Ultrasound

University of Maryland Medical Center

Baltimore, Maryland

1600 John F. Kennedy Blvd.

Ste 1800 Philadelphia, PA 19103-2899

IMAGING ANATOMY: ULTRASOUND, SECOND EDITION

ISBN: 978-0-323-54800-7

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Publisher Cataloging-in-Publication Data

Names: Woodward, Paula J.

Title: Imaging anatomy. Ultrasound / [edited by] Paula J. Woodward. Other titles: Ultrasound.

Description: Second edition. | Salt Lake City, UT : Elsevier, Inc., [2017] | Includes bibliographical references and index.

Identifiers: ISBN 978-0-323-54800-7

Subjects: LCSH: Human anatomy--Handbooks, manuals, etc. | Ultrasonic imaging--Handbooks, manuals, etc. | MESH: Ultrasonography--methods--Atlases. | Anatomy, Cross-Sectional--Atlases.

Classification: LCC QM25.I43 2017 | NLM WN 17 | DDC 616.07’543--dc23

International Standard Book Number: 978-0-323-54800-7

Cover Designer: Tom M. Olson, BA

Cover Art: Richard Coombs, MS

Printed in Canada by Friesens, Altona, Manitoba, Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contributing Authors

Jill M. Abrigo, MD, DPBR

Clinical Tutor

Department of Diagnostic Radiology and Organ Imaging

The Chinese University of Hong Kong Hong Kong (SAR), China

Shweta Bhatt, MD

Associate Professor

Department of Imaging Sciences

University of Rochester Medical Center Rochester, New York

Winnie C. W. Chu, MBChB, FRCR

Professor

Department of Diagnostic Radiology and Organ Imaging

The Chinese University of Hong Kong Hong Kong (SAR), China

Richard E. Fan, PhD

Engineering Research Associate Department of Urology

Stanford University School of Medicine Stanford, California

Bryan R. Foster, MD

Assistant Professor

Department of Radiology

Oregon Health & Science University Portland, Oregon

Simon S. M. Ho, MBBS, FRCR

Assistant Professor

Department of Diagnostic Radiology and Organ Imaging

The Chinese University of Hong Kong Hong Kong (SAR), China

Stella Sin Yee Ho, RDMS, RVT, PhD

Adjunct Associate Professor

Department of Imaging & Interventional Radiology

Prince of Wales Hospital

Faculty of Medicine

The Chinese University of Hong Kong Hong Kong (SAR), China

Anne Kennedy, MD

Professor of Radiology

Adjunct Professor of Obstetrics and Gynecology

Executive Vice Chair of Radiology

Codirector of Maternal Fetal Diagnostic Center

University of Utah School of Medicine

Salt Lake City, Utah

Barton F. Lane, MD

Assistant Professor

Clinical Director of CT

Department of Diagnostic Radiology and Nuclear Medicine

University of Maryland School of Medicine

Baltimore, Maryland

Ryan K. L. Lee, MBChB, FRCR, FHKAM (Radiology)

Associate Consultant and Clinical Assistant

Professor (Honorary)

Department of Imaging and Interventional Radiology

Prince of Wales Hospital Faculty of Medicine

The Chinese University of Hong Kong

Hong Kong (SAR), China

Yolanda Y. P. Lee, MBChB, FRCR, FHKCR, FHKAM (Radiology)

Associate Consultant and Clinical Associate Professor (Honorary)

Department of Imaging and Interventional Radiology

Prince of Wales Hospital

Faculty of Medicine

The Chinese University of Hong Kong

Hong Kong (SAR), China

Vivian Y. F. Leung, PhD, RDMS

Adjunct Assistant Professor

Department of Diagnostic Radiology and Organ Imaging

The Chinese University of Hong Kong

Hong Kong (SAR), China

Eric K. H. Liu, PhD, RDMS

Adjunct Associate Professor

Department of Imaging and Interventional Radiology

The Chinese University of Hong Kong

Hong Kong (SAR), China

Chander Lulla, MD, DMRD

Consultant Sonologist

RIA Clinic

Mumbai, India

Thomas A. Miller, DO

Assistant Professor of Pediatrics

Division of Pediatric Cardiology

University of Utah Salt Lake City, Utah

L. Nayeli Morimoto, MD

Clinical Instructor

Department of Radiology

Stanford University School of Medicine Stanford, California

Alex W. H. Ng, MBChB, FRCR, FHKCR, FHKAM (Radiology)

Consultant and Clinical Associate Professor (Honorary) Department of Imaging and Interventional Radiology

Prince of Wales Hospital

Faculty of Medicine

The Chinese University of Hong Kong Hong Kong (SAR), China

Bhawan K. Paunipagar, MBBS, MD, DNB

Senior Consultant Radiologist, Head of MRI/CT Division

Department of Radiology

Wockhardt Hospitals, South Mumbai Mumbai, Maharashtra, India

Michael D. Puchalski, MD

Professor of Pediatrics

Adjunct Professor of Radiology

Associate Director of Pediatric Cardiology Director of Non-Invasive Imaging

University of Utah/Primary Children’s Hospital Salt Lake City, Utah

Deyond Y. W. Siu, MBChB, FRCR

Honorary Clinical Tutor

Department of Diagnostic Radiology and Organ Imaging

The Chinese University of Hong Kong Hong Kong (SAR), China

Roya Sohaey, MD

Professor of Radiology

Adjunct Professor of Obstetrics and Gynecology

Director of Fetal Imaging

Oregon Health & Science University

Portland, Oregon

Sathi A. Sukumar, MBBS, FRCP (UK), FRCR

Consultant Radiologist

University Hospital of South Manchester Manchester, United Kingdom

Ali M. Tahvildari, MD

Staff Radiologist

VA Palo Alto Healthcare System

Palo Alto, California

Clinical Instructor (Affiliated) Department of Radiology

Stanford University School of Medicine

Stanford, California

Katherine To’o, MD

Staff Radiologist

Veterans Affairs Palo Alto Health Care System

Palo Alto, California

Ashish P. Wasnik, MD

Assistant Professor Department of Radiology Division of Abdominal Imaging University of Michigan Health System

Ann Arbor, Michigan

Nicole S. Winkler, MD

Assistant Professor of Radiology University of Utah Salt Lake City, Utah

Acknowledgments

Lead Editor

Matt W. Hoecherl, BS

Text Editors

Arthur G. Gelsinger, MA

Nina I. Bennett, BA

Terry W. Ferrell, MS

Lisa A. Gervais, BS

Karen E. Concannon, MA, PhD

Megg Morin, BA

Image Editors

Jeffrey J. Marmorstone, BS

Lisa A. M. Steadman, BS

Illustrations

Richard Coombs, MS

Lane R. Bennion, MS

Laura C. Wissler, MA

Art Direction and Design

Tom M. Olson, BA

Laura C. Wissler, MA

Production Coordinators

Rebecca L. Bluth, BA

Angela M. G. Terry, BA

Emily C. Fassett, BA

ScalpandCalvarialVault

TERMINOLOGY

Definitions

•Fontanelle:Broadareasofconnectivetissueatjunctionof majorsutures

GROSSANATOMY

Overview

• Scalp

○Scalphas5layers

–Skin(epidermis,dermis,hair,sebaceousglands)

–Subcutaneoustissue(veryvascularfibroadipose tissue)

–Epicranialtissue(scalpmuscles,galeaaponeurotica)

–Subaponeurotictissue(looseareolarconnective tissue)

–Pericranium(periosteumofskull)

•Skull(28separatebones,mostlyconnectedbyfibrous sutures)

○Craniumhasseveralparts

–Calvarialvault

–Cranialbase

–Facialskeleton

○Calvarialvaultcomposedofseveralbones

–2frontalbonesseparatedbymetopicsuture

–Pairedparietalbones

–Squamousoccipitalbone

–Pairedsquamoustemporalbones

○3majorserratedfibrousjoints(sutures)connectbones ofvault

–Coronalsuture

–Sagittalsuture

–Lambdoidsuture

○Outer,innertables

–2thinplatesofcompactcorticalbone

–Separatedbydiploicspace(cancellousbone containingmarrow)

○Endocranialsurface

–Linedbyouter(periosteal)layerofdura

–Groovedbyvascularfurrows

–Mayhaveareasoffocalthinning(arachnoid granulations),foramina(emissaryveins)

IMAGINGANATOMY

Overview

•Scalp:Hypoechoic,5layerscannotbefurtherseparately resolved

•Calvariumechogenicouter/innertables;diploicspacefilled withfattymarrowandappearshypoechoic,sutureappears asgapbetweenechogeniccalvarium

•Frontalbones

○Frontalsinusesshowwidevariationinaeration

○Frontalbonesoftenappearthickened,hyperostotic (especiallyinolderfemales)

•Parietalbones

○Areasofparietalthinning,granularfoveolae(for arachnoidgranulations)commonadjacenttosagittal suture

○Innertablesoftenslightlyirregular(convolutional markingscausedbygyri),groovedbypairedmiddle meningealarteries+vein

•Occipitalbone

○Deeplygroovedbysuperiorsagittal,transversesinuses

○Internaloccipitalprotuberancemarkssinusconfluence (torcularHerophili)

•Temporalbones

○Thin,innersurfacegroovedbymiddlemeningealvessels

○Outersurfacegroovedbysuperficialtemporalartery

•Fontanelle:ProvideacousticwindowforUSexaminationof underlyingbrainparenchyma

○ Anteriorfontanelle

○Between2frontaland2parietalbones,usually disappearsbyage2

○Whenfused,correspondstobregma:Meetingof sagittal,coronalsutures

○ Posteriorfontanelle

○Small,usuallyclosesbetween3-6monthsofage

○Whenfused,correspondstolambda:Meetingofsagittal, lambdoidsutures

○Pterion

–Anterolateralfontanelle;closesbetween3-6months ofage

–H-shapedjunctionbetweenfrontal,parietalbones+ greatersphenoidwing,squamoustemporalbone

○Asterion

–Posterolateralfontanelle,persistsuntil2yearsofage

○ Mastoidfontanelle

○Locatedatjunctionoftemporosquamousandlambdoid sutures

○Persistsuntil2years

ANATOMYIMAGINGISSUES

ImagingRecommendations

•High-frequencylineararraytransducersprovidesuperb resolutionofnear-fieldstructures

•Goodskin-to-transducercouplingachievedbycopioususe ofacousticcouplinggel

•Superficialstandoffpadcanbeusedtoincreasedepthof focalzone

•UScanbeusedtoevaluatecranialsuturesandassists diagnosisofcraniosynostosis(prematurefusionofsutures)

EMBRYOLOGY

EmbryologicEvents

•Skullbaseformedfromendochondralossification

•Calvarialvaultformsviamembranousossification

○Curvedmesenchymalplatesappearatday30

○Extendtowardeachother,skullbase

○Aspairedbonesmeetinmidline,metopicandsagittal suturesareinduced(coronalsutureispresentfrom onsetofossification)

○Unossifiedcentersatedgesofparietalboneform fontanelles

○Vaultgrowsrapidlyin1stpostnatalyear

Suture

ScalpandCalvarialVault

Suture

(Top)CoronalUSthroughtheanteriorfontanelleshowsthescalpandcalvarium.Thereisdiscontinuityinahypoechoicbandextending fromtheoutertoinnertableofthecalvarialvault.Thisrepresentsanormalsuture.Thescalpappearshypoechoiccomparedtothe echogenicouterandinnertablesofthecalvarium.The5layersofthescalpcannotberesolvedbyUS.(Middle)CoronalUSthroughthe anteriorfontanelleshowsanothersutureofthecalvarialvault.Thewidthandcurvatureofsuturesisvariableandshouldnotbe mistakenforabonyfracture.(Bottom)SagittalT2MRofthescalpandcalvariumisshown.Thesuturelineappearswiththesame signalintensityastheouterandinnertableofcalvarium.Corticalveinscanbeseenwithinthehyperintensesubarachnoidspace,which isimmediatelyundertheinnertable.

Scalp

Calvarium

Scalp

Suture

Scalp

Corticalvv.insubarachnoidspace

Cerebralcortex

Outertableofcalvarium

Innertableofcalvarium

USANDT2WIMRCALVARIUM

Imaging anatomy. ultrasound 2nd edition paula j. woodward - Download the ebook now to never miss imp

SECOND EDITION

Paula J. Woodward, MD

of Radiology

Notices

Contributing Authors

Acknowledgments

Lead Editor

Text Editors

Image Editors

Illustrations

Art Direction and Design

Production Coordinators

TABLEOFCONTENTS

TABLEOFCONTENTS

TABLEOFCONTENTS

WOODWARD

ScalpandCalvarialVault

TERMINOLOGY

GROSSANATOMY

IMAGINGANATOMY

ScalpandCalvarialVault